目的:利用人工智能神经网络方式构建ICF康复组合(ICF-RS)评定量化标准总体及三个维度(身体功能、活动、参与)功能分级的算法模型,为应用ICF-RS评定量化标准进行数据分析及功能分级提供解决方案.方法:本研究利用中文版ICF-RS评定量化标准,通过多中心合作,采用分层比例抽样的方法收集了 6家已开展ICF-RS评定量化标准临床应用的康复医学科住院患者ICF-RS数据,以多个专家对同一患者的方式获取ICF-RS评定量化标准三个维度及整体功能状况的等级评价结果.借助于神经网络算法构建ICF-RS评定量化标准的各维度及整体功能分级模型,采用计算机k折交叉验证法选择最优模型参数,并计算模型预测受试者工作特征曲线[receiver operating characteristic(ROC)curve]下面积(area under ROC curve,AUC)、准确率(accuracy,ACC)和F1 分数(F1-score).模型构建后,再通过专家和患者一对一的方式收集100例ICF-RS数据用于对已建立的模型进行临床再测试,通过计算ROC、AUC、ACC和F1对模型性能进行评价.结果:共收集584例住院患者的ICF-RS数据,其中484例数据用于构建及验证模型,100例数据用于测试模型的预测性能.根据k折交叉验证法结果显示,身体功能维度、活动维度、参与维度及整体ICF-RS功能分级模型的AUC分别是 89.00％、92.00％、87.00％和87.00％,ACC分别达到75.19％、78.10％、72.91％和73.53％,F1分别是73.68％、77.04％％、69.28％、58.95％.在模型建立后将重新收集到的100例ICF-RS数据输入模型计算,发现各模型ROC曲线良好,AUC 分别是 89.04％、91.81％、86.85％、86.89％,ACC 分别是 64.00％、72.00％、61.00％、65.00％,F1 分别是 48.30％、59.95％、64.06％、49.35％.结论:基于神经网络建立的ICF-RS整体及各维度功能分级算法模型对ICF-RS数据的功能等级预测准确率良好,预测价值较高,具有良好的临床应用价值.

ObjectiveTo observe the effect of transcranial direct current stimulation (tDCS) synchronized with normal walking pattern based on multi-channel functional electrical stimulation (FES) on lower limb motor and balance function in patients with traumatic brain injury hemiplegia.MethodsA total of 56 patients with TBI and hemiplegia were divided into synchronous group (n=21), FES group (n=20), and tDCS group (n=15) by using sealed-envelope randomization. The tDCS group was given head tDCS treatment and lower extremity sham FES treatment, the FES group was given head sham tDCS treatment and lower extremity FES treatment, and the synchronous group was given head tDCS treatment and lower extremity FES treatment. The treatment was 20 min/time, 1 time/d, for 12 days. Before treatment, after 6 days treatment and after 12 days treatment, the following scales were used to evaluate: Fugl-Meyer assessment of lower extremity (FMA-LE), Berg balance scale (BBS), and Neurocom Balance Manager System.ResultsThere was no significant differences among the evaluation results of the three groups before treatment. After treatment, compared with those before treatment, the FMA-LE scores of three groups were significantly different (P<0.05), but there was no significant differences in FMA-LE among the three groups (P>0.05). Compared with the three groups before and after treatment, BBS scores of the three groups were significantly different respectively (P<0.05). Compared the tDCS group with the FES group, the differences in BBS scores of the synchronization group were significant (P<0.05). In balance assessment, compared with those before treatment, visual cues (VIS), vestibular cues (VEST), sensory organization test composite (SOTC) and motion control test composite (MCTC) were significantly different in the synchronous group after treatment (P<0.05); MCTC was significantly different in the FES group (P<0.05); VIS and SOTC was significantly difference in the tDCS group (P<0.05). Compared among the three groups, the change rate of MCTC was significantly difference (P<0.05); there were no significant differences in other indicators (P>0.05).ConclusionThe three methods can effectively improve the lower limb motor and balance function of patients with traumatic brain injury in chronic period. The treatment of tDCS with FES is better than the treatment of tDCS or FES alone in terms of some evaluation indicators.

目的:观察巨刺法穴位埋线治疗脑卒中偏瘫的临床疗效.方法:选取2019年1月～2020年12月在广东三九脑科医院康复医学科住院的脑卒中偏瘫患者90例,按照随机数字表法分为治疗组和对照组各45例,均予常规针刺结合现代康复训练(每天1次,共治疗4周),治疗组则在此基础上给予巨刺法穴位埋线(每10天1次,共治疗3次),治疗前后对患者进行简式Fugl-Meyer运动功能评定(FMA)及Berg平衡量表(BBS)、Barthel指数(BI)评估.结果:治疗后,两组患者FMA、BBS、BI与治疗前相比均有所提高,差异均有统计学意义(P<0.01);治疗组治疗后FMA、BBS、BI评分比对照组高,差异均有统计学意义(P<0.01).结论:巨刺法穴位埋线可有效改善脑卒中偏瘫患者的肢体运动功能、平衡功能及日常生活活动能力.

目的:观察经颅直流电刺激(transcranial direct current stimulation,tDCS)同步基于正常行走模式的下肢多通道功能性电刺激(functional electrical stimulation,FES)对脑卒中偏瘫恢复期患者下肢运动功能的影响.方法:66例符合入组条件的脑卒中偏瘫患者,分层后随机分成3组:tDCS组(n=22)、FES组(n=22)、同步组(n=22).tDCS组给予头部tDCS治疗同步下肢安慰FES治疗;FES组给予头部安慰tDCS治疗同步下肢FES治疗;同步组给予头部tDCS治疗同步下肢FES治疗.治疗20min/次、1次/d、连续治疗12d.在治疗前(T0)、治疗6次(T1)及治疗12次(T2)后分别采用下列量表评估:脑卒中患者姿势评分(PASS)、Fugl-Meyer下肢运动功能评定(FMA-L)、Berg平衡量表(BBS)、计时"起立-行走"测试(TUGT)、改良Barthel指数(MBI).结果:治疗前3组患者各评定结果之间的差异无显著性.治疗12次后,三组患者的BBS、TUGT、MBI(下肢)及FES组和同步组的PASS较治疗前差异有显著性(P＜0.05).变化率比较,治疗12次后三组患者FMA-L、BBS、TUGT、MBI(下肢)及FES组和同步组的PASS的变化率,较治疗6次时变化率差异均有显著性.tDCS组与FES组比较,MBI(下肢)差异有显著性(P＜0.05);同步组与tDCS组比较,PASS、MBI(下肢)差异有显著性(P＜0.05);同步组与FES组比较BBS变化率差异有显著性(P＜0.05).其余变化差异无显著性.结论:三种方法均可有效改善脑卒中后恢复期偏瘫患者的下肢功能,tDCS同步FES的治疗在部分评估指标方面的疗效优于单用tDCS或单用FES治疗.

目的:观察经颅直流电刺激(tDCS)同步多通道功能性电刺激(FES)的治疗模式对脑卒中偏瘫患者平衡与行走功能的影响.方法:将脑卒中偏瘫步行障碍患者随机分为tDCS组(20例)和伪tDCS组(18例).tDCS组采用1×1 tDCS治疗仪,阳极置于脑初级运动皮层偏瘫下肢代表区,阴极置于健脑额前区,电流强度:2mA.伪tDCS组患者电极放置位置相同,但仅在开始治疗和结束前30s有电流输出.两组均同步接受FES治疗.治疗时间:20min/次,1次/天,5天倜,连续治疗2周.治疗前、1周后、2周后分别给予Berg平衡量表(BBS)、Holden步行功能量表的临床评估,并在治疗前和2周后进行三维步态分析.结果:治疗组1周后BBS变化率、2周后Holden等级较伪刺激组增加,差异具有显著性(P＜ 0.05);治疗组步态的特征性参数、时空参数、对称性参数与伪刺激组比较,差异无显著性.结论:tDCS同步FES治疗可能提高脑卒中偏瘫患者的平衡功能,可以显著提高其行走功能,但三维步态分析的步态参数变化不明显.

目的:通过三维步态分析系统,观察基于正常行走模式的功能性电刺激(FES)对脑卒中患者行走功能的即时影响,为其临床应用及推广提供依据.方法:将符合入组条件的47例脑卒中患者随机分为电刺激组(16例)、安慰电刺激组(15例)和对照组(16例).电刺激组给予基于正常行走模式设计的四通道FES助行仪治疗,患者戴机行走5min;刺激肌肉分别为偏瘫侧胫前肌、股四头肌、腓肠肌及胭绳肌.安慰电刺激组的电刺激位置及行走时间与电刺激组相同,行走(5min)过程中没有电流输出;对照组不给予电刺激,只让患者行走5min.三组患者分别在治疗前及治疗5min后接受三维步态检查,并对结果进行分析.结果:三组组内治疗后与治疗前比较:电刺激组的步行周期、支撑时间、步行速度、步频、踝背伸角度、踝关节触地时角度均有改善(P＜0.05);安慰电刺激组仅在踝关节背伸和踝关节触地时角度有改善(P＜0.05);对照组所有参数均无改善,且跨步长缩短、踝关节背伸角度降低(P＜0.05).三组组间比较:治疗后只有触地时踝关节背伸角度差异有显著性意义(P＜0.05).进一步进行治疗前后变化率的组间比较,发现三组患者患侧步行周期、支撑时间、步行速度、步频、步长、跨步长、触地时踝关节背伸角度的差异均有显著性意义(P＜0.05).结论:应用基于正常行走模式的FES治疗5min即可改善脑卒中患者的即时步行功能,长期效果尚待研究.

目的:探讨心理健康水平对接受功能性电刺激(FES)治疗的由脑卒中引起的足下垂患者康复的作用.方法:120例脑卒中患者,随机分为常规治疗组(对照组,n=60)、心理干预组(观察组,n=60).心理干预组为常规治疗组基础上增加心理干预,常规治疗组采用FES康复训练.结果:两组患者基础数据无显著性差异(均P>0.05).经过4周治疗,两组患者评价指标得分均有所改善,对照组和观察组的MAS评分为3.20±0.51和3.70±0.24;RSB评分为3.80±0.45和4.20±0.17,均有显著性差异.心理干预组患者SCL-90总分(112.70±25.73)以及总均分(1.25±0.29)均显著优于常规治疗组(127.40±22.14和1.42±0.25)(均P<0.05).结论:FES结合心理干预疗法,能够促进脑卒中足下垂患者肢体和心理健康.

Objective:To evaluate the function of patients with cerebral hemorrhage and guide the clinical rehabilitation practice based on the International Classification of Function, Disability and Health Rehabilitation Set (ICF-RS).Methods:One case of cerebral hemorrhage was collected, the patient's medical history, past history, auxiliary examination, routine rehabilitation evaluation and clinical diagnosis were analyzed. The patient with cerebral hemorrhage was evaluated by ICF-RS assessment standard with 30 categories, and the patient was treated with rehabilitation intervention according to the evaluation results.After two weeks' intervention, the functional changes of patients before and after treatment were compared.Results:After two weeks' intervention, the patient's physical function, activity and participation were improved than those before treatment.Conclusion:ICF-RS assessment standard can better reflect the changes of the patient's functional level, and has good reliability and validity, It can be widely used in clinical practice.

目的 探讨高压氧对颅脑外伤患者的认知功能及肺部感染的临床治疗作用.方法 收集颅脑外伤患者100例,分为试验组和对照组各50例,试验组患者在常规临床治疗基础上增加高压氧治疗,对照组患者进接受常规临床治疗.观察患者住院期间在治疗前、第1周、2周和3周时的GCS评分的变化,第2周和3周时的MMSE评分,同时记录患者肺部感染的发生率.结果 两组患者的GCS和MMSE评分随着时间的延长逐渐增大,在第2周和3周时两组患者的GCS和MMSE评分均存在显著差异P<0.05,其中试验组的GCS和MMSE评分均大于对照组的相应评分;试验组患者的肺部感染显著低于对照组.结论 早期高压氧治疗可以促进脑外伤患者的觉醒,提高患者认知功能,降低肺部感染率的发生.

Objective:To observe the differences in the importance of the items in the conscious state assessment of the Coma Recovery Scale-Revised (CRS-R).Methods:A total of 480 patients with disturbance of consciousness were assessed by Chinese version of CRS-R. The data were introduced into SPSS 17.0 statistical software, and the correlation between each project and the state of consciousness was analyzed by using the correlation analysis function and decision tree function. It was analyzed whether the difference of this correlation was statistically significant.Results:The correlation between exercise, hearing, visual and consciousness status was the highest; the difference between exercise and other items was statistically significant (P<0.05), auditory, visual and other items (P<0.05), but the difference between auditory and visual acuity was not statistically significant (P>0.05).Conclusion:The CRS-R are different in the importance of the state of mind assessment, and the exercise, hearing and visual needs are more important than other items.

低频电是指频率低于1000Hz的交流电,其作一种物理因子用于临床治疗已有百年历史.低频电为一种小电流,电解作用弱,对感觉神经和运动神经都有强的刺激作用,但不会产生明显温热作用.在1790年,Luigi Galvani首次观察到应用电流刺激青蛙腿部肌肉能诱发运动,在1831年,Michael Faraday发现电流刺激神经可以产生主动运动,这是最早观察到电流与神经肌肉之间的关系.

Objective To observe the clinical efficacy of Zhuang’s Moxibustion plus acupuncture in treating spastic paralysis due to craniocerebral injury.Method Ninety-two patients with spastic paralysis due to craniocerebral injury were randomized into a treatment group of 60 cases and a control group of 32 cases. The control group was intervened by conventional internal medicine and rehabilitation, while the treatment group was intervened by Zhuang’s moxibustion plus acupuncture in addition to the intervention given to the control group. The modified Ashworth Scale (MAS) was adopted to evaluate the clinical efficacy.Result The total effective rate was 75.0% in the treatment group versus 65.6% in the control group, and the between-group difference was statistically significant (P<0.01).Conclusion Zhuang’s moxibustion plus acupuncture is an effective approach in treating spastic paralysis due to craniocerebral injury.

目的 探讨早期运动训练在提高卒中相关性肺炎临床疗效中的作用.方法 选取我院收治的被确诊为卒中相关性肺炎的患者80例,分为试验组和对照组各40例,对照组患者接受常规临床治疗,试验组患者在常规治疗的基础上接受运动训练,运动训练项目包括被动运动、床边站立及肢体低频电刺激,两组患者治疗的时间均为4周.观察两组患者C反应蛋白(CRP)和降钙素原(PCT)7天内变化情况.结果 试验组患者的CRP和PCT在7天内下降的速率显著大于对照组(P<0.05),试验组患者7天后的CRP和PCT值显著小于对照组(P<0.05),结论 早期运动训练有助于促进卒中相关性肺炎的恢复,改善卒中相关性肺炎患者的功能预后.